Lexapro: 7 things you should know

Medically reviewed by Carmen Fookes, BPharm. Last updated on Feb 28, 2023.

1. How it works

• Lexapro is a brand name for escitalopram which may be used to treat certain conditions associated with mood.
• Experts aren't sure exactly how Lexapro works but believe its effects are due to its ability to block the reuptake of serotonin by nerves. This results in an increase in serotonin concentrations in the nerve synapse (the space between two nerves).
• Lexapro belongs to a class of medicines known as Selective Serotonin Reuptake Inhibitors (SSRIs).

2. Upsides

• Used to relieve depression and anxiety in adults, and depression in teenagers aged 12 through 17.
• Less likely to cause drowsiness than some other antidepressants.
• Has also been used off-label for other conditions such as panic disorder and post-traumatic stress disorder.
• SSRIs in general, are better tolerated than many other medicines used in the treatment of depression.
• May be more effective with fewer adverse effects than other SSRIs.
• Lexapro is available as a generic under the name of escitalopram.

3. Downsides

If you are between the ages of 18 and 60, take no other medication or have no other medical conditions, side effects you are more likely to experience include:

• Insomnia or drowsiness, sexual dysfunction, nausea, dry mouth, and increased sweating.
• As with other antidepressants, Lexapro may increase the risk of suicidal thoughts or behavior; the risk is higher in children and young adults aged less than 24. Monitor for worsening mood.
• May precipitate a manic episode in people with undiagnosed bipolar disorder.
• May cause a lowering of total body sodium (hyponatremia); elderly people or people taking diuretics or already dehydrated may be more at risk.
• May impair judgment and affect your ability to drive or operate machinery. Avoid alcohol.
• May cause a discontinuation syndrome if abruptly stopped or interrupted (symptoms include nausea, vomiting, diarrhea, headaches, dizziness, sweating, chills, tremors, vivid dreams, and insomnia); taper off dosage slowly over several weeks to months.
• Interaction or overdosage may cause serotonin syndrome (symptoms include mental status changes [such as agitation, hallucinations, coma, delirium]), fast heart rate, dizziness, flushing, muscle tremor or rigidity, and stomach symptoms (including nausea, vomiting, and diarrhea]).
• May increase the risk of bleeding, especially if used with other drugs that also increase bleeding risk. Rarely associated with seizures.
• Seek medical advice if a rash develops while taking Lexapro. Discontinue if a severe allergic reaction to Lexapro occurs and seek urgent medical advice.
• May interact with several other drugs including other antidepressants, tramadol, bupropion, diuretics, St John's Wort, and drugs that prolong the QT interval (such as pimozide or thioridazine).
• May not be suitable for some people including those with glaucoma, bleeding disorders, a history of seizures, liver or kidney disease, the elderly, or certain heart conditions. People with diabetes may need the dosage of their medication adjusted.

Note: In general, seniors or children, people with certain medical conditions (such as liver or kidney problems, heart disease, diabetes, seizures) or people who take other medications are more at risk of developing a wider range of side effects. View complete list of side effects

4. Bottom Line

• Lexapro is an effective antidepressant that may have less potential for adverse effects than other SSRI antidepressants.

5. Tips

• Take Lexapro with or without food. Dosage adjustments should be made no more frequently than weekly - your doctor will advise you on this.
• Do not stop suddenly as withdrawal symptoms may occur.
• Do not drive or operate machinery if this medicine makes you drowsy or impairs your judgment. Avoid alcohol.
• Be alert for worsening mood and suicide-related thoughts or behaviors. Seek medical advice if changes are apparent.
• Seek urgent medical advice if symptoms consistent with serotonin syndrome (such as agitation, hallucinations, fast heart rate, dizziness, flushing, nausea, or diarrhea) develop.
• Talk to your doctor immediately if you develop a rash or seek urgent medical advice with severe allergy-type symptoms such as swelling of the face or throat, or shortness of breath.
• Do not take any other medicines, including those bought over-the-counter, without first consulting a doctor or pharmacist and asking if the medicine is safe to take with Lexapro.
• Talk with your doctor if you experience any: unusual bruising or increased bleeding while taking Lexapro, persistent headaches, confusion, weakness, or unsteadiness resulting in falls.
• Other reasons to visit your doctor include an increase, irregularity, or slowing of your heart rate or shortness of breath, eye pain or swelling or visual disturbances, seizures, manic behavior such as recklessness, racing thoughts, increased energy, or severe difficulty in sleeping.

6. Response and effectiveness

• Peak blood levels are reached approximately 5 hours after a dose but it may take up to a week for levels to become stabilized in the body. An improvement in depressive or anxiety symptoms may not be noticed for 1-4 weeks. Treatment should be continued as directed even after improvement.

7. Interactions

Medicines that interact with Lexapro may either decrease its effect, affect how long it works, increase side effects, or have less of an effect when taken with Lexapro. An interaction between two medications does not always mean that you must stop taking one of the medications; however, sometimes it does. Speak to your doctor about how drug interactions should be managed.

Common medications that may interact with Lexapro include:

• anti-anxiety medications such as lorazepam
• antipsychotics such as lithium and thioridazine
• aspirin and other NSAIDs, such as ibuprofen, diclofenac, and naproxen
• indigestion remedies, such as cimetidine
• migraine medications such as eletriptan, rizatriptan, or zolmitriptan
• monoamine oxidase inhibitors (MAOIs), such as isocarboxazid, phenelzine, or selegiline
• other antidepressants, such as amitriptyline and desipramine
• other SSRIs, such as citalopram or fluoxetine
• sleeping pills such as triazolam or zopiclone
• some antibiotics such as linezolid
• some antifungals such as ketoconazole
• some diabetes medications such as pioglitazone and rosiglitazone
• St John's Wort
• Tramadol
• warfarin and other anticoagulants
• other medications that may thin the blood,

Note that this list is not all-inclusive and includes only common medications that may interact with Lexapro. You should refer to the prescribing information for Lexapro for a complete list of interactions.

References

• Lexapro (escitalopram oxalate) [Package Insert]. Revised 09/2021. Allergan, Inc. https://www.drugs.com/pro/lexapro.html

Further information

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use Lexapro only for the indication prescribed.

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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